Provider Demographics
NPI:1962651083
Name:JACKSON, CYRENA BROWN (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:CYRENA
Middle Name:BROWN
Last Name:JACKSON
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:659 RUE SAINT MICHAEL
Mailing Address - Street 2:
Mailing Address - City:TERRYTOWN
Mailing Address - State:LA
Mailing Address - Zip Code:70056-8224
Mailing Address - Country:US
Mailing Address - Phone:504-234-1056
Mailing Address - Fax:
Practice Address - Street 1:3601 SAINT CLAUDE AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70117-5745
Practice Address - Country:US
Practice Address - Phone:504-322-2200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-12
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA17071183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist